手术治疗腰椎滑脱伴发椎管内囊肿  

Surgical treatment of lumbar spondylolisthesis combined with synovial cyst

作　　者：孔维清[1] 徐建广[1] 眭述平[1] 张长青[1] 曾炳芳[1] 

机构地区：[1]上海交通大学附属第六人民医院骨科,上海200233

出　　处：《上海医学》2012年第11期951-953,I0006,共4页Shanghai Medical Journal

摘　　要：目的探讨手术治疗腰椎滑脱伴发椎管内囊肿的临床疗效。方法对临床腰椎滑脱伴同节段椎管内硬脊膜外腔占位的25例患者实施后路减压、肿块切除、滑脱节段融合内固定术。25例患者的年龄为41～68岁,平均年龄为(54±6)岁;男15例,女10例;L4、L5节段滑脱14例,L5、S1节段滑脱11例;术前患者均伴不同程度腰痛及下肢放射症状。滑脱程度:Ⅰ度10例,Ⅱ度9例,Ⅲ度6例。术前常规行MRI检查,术后对肿块行病理检查。随访患者术后融合情况并进行日本矫形外科协会(JOA)评分。结果所有患者术中完整切除肿块,术后病理检查均示椎管内囊肿。随访6～12个月,所有患者均获得骨性融合。术后的JOA评分为(19.5±3.1)分,显著高于术前的(12.0±2.3)分(P<0.05)。结论腰椎滑脱常伴发椎管内囊肿,在彻底切除肿块的同时行滑脱节段融合内固定术有利于缓解患者的临床症状,防止囊肿复发。对腰椎滑脱患者术前须常规行MRI检查以免遗漏椎管内囊肿的诊断。Objective To explore the clinical outcomes of surgical treatment for lumbar spondylolisthesis combined with synovial cyst. Methods Posterior decompression, cyst resection and interbody fusion were performed in 25 patients with lumbar spondylolisthesis combined with synovial cyst. There were 15 males and 10 females with an average age of （54±6） years （range from 41 to 68 years）. Affected segments： L4 -L5 in 14 cases and L5 - S1 in 11 cases. Low back pain and radiating pain in lower limb appeared in all the patients. According to Meyerding classification, there were 10 cases with spondylolisthesis of Ⅰ degree, 9 cases with Ⅱdegree and 6 cases with Ⅲdegree. Preoperative magnetic resonance imaging （MRI） and postoperative pathological examination were conducted routinely. Bone fusion was evaluated and Japanese Orthopaedic Association （JOA） score was recorded during follow-up. Results Synovial tumor was resected completely in all patients and was confirmed to be cyst by pathological examination. The follow-up ranged from 6 months to 12 months. Bone fusion was seen in all patients. JOA score significantly increased from 12.0 ±2.3 preoperatively to 19.5 ±3. 1 postoperatively （P〈0.05）. Conclusion Lumbar spondylolisthesis is usually combined with synovial cyst. Interbedy fusion and cyst resection can alleviate pain and prevent recurrence. It is necessary to take MRI for the patients with lumbar spondylolisthesis to avoid missed diagnosis of synovial cyst.

关 键 词：腰椎滑脱 椎管内囊肿 腰椎不稳 

分 类 号：R687.3[医药卫生—骨科学]